Wiki Post-op Subsequent Visits

[KJenkins588]

Hello all,
Here is the issue we are having. Patient has surgery and is now in a global. The NP in our practice would like to continue billing during the post-op because she is insistent that she is treating other issues that the patient has. Some of these issues effect the condition that the patient had surgery for and others do not.
I have told her that if the issues that she is treating has nothing to do with the condition that surgery was for it is okay to bill and we'll add the modifier to the charge to show this.
Here is where it gets tricky -- at times a hospitalist can be involved in the patient's care as well to treat those other conditions and issues.
I can recall being taught when I first started that we can not put through two E/M services, even if it is different specialties, if it's for the same condition/issues.

Is that correct thinking? And if so is that in writing somewhere that someone can direct me to?
Without proper documentation outlining this rule she is adamant that she should continue billing.

Anyone's help out me greatly appreciated!
Thank you!

 

[danskangel313]

Hello all,
Here is the issue we are having. Patient has surgery and is now in a global. The NP in our practice would like to continue billing during the post-op because she is insistent that she is treating other issues that the patient has. Some of these issues effect the condition that the patient had surgery for and others do not.
I have told her that if the issues that she is treating has nothing to do with the condition that surgery was for it is okay to bill and we'll add the modifier to the charge to show this.
Here is where it gets tricky -- at times a hospitalist can be involved in the patient's care as well to treat those other conditions and issues.
I can recall being taught when I first started that we can not put through two E/M services, even if it is different specialties, if it's for the same condition/issues.

Is that correct thinking? And if so is that in writing somewhere that someone can direct me to?
Without proper documentation outlining this rule she is adamant that she should continue billing.

Anyone's help out me greatly appreciated!
Thank you!

First thing, see pg 48:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf
"Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.

Contractors pay a physician for only one hospital visit per day for the same patient, whether the problems seen during the encounters are related or not. The inpatient hospital visit descriptors contain the phrase “per day” which means that the code and the payment established for the code represent all services provided on that date. The physician should select a code that reflects all services provided during the date of the service. In a hospital inpatient situation involving one physician covering for another, if physician A sees the patient in the morning and physician B, who is covering for A, sees the same patient in the evening, contractors do not pay physician B for the second visit. The hospital visit descriptors include the phrase “per day” meaning care for the day. If the physicians are each responsible for a different aspect of the patient’s care, pay both visits if the physicians are in different specialties and the visits are billed with different diagnoses.”


And for the "separate" E/Ms that the NP wants to bill, I assume the modifier you're referring to is the 24? If so, the link below might be helpful (it's carrier-specific, but modifiers are modifiers). "Do not use this modifier when the E/M is not clearly shown to be unrelated to the surgery in the medical record documentation."
https://med.noridianmedicare.com/web/jeb/topics/modifiers/24

If there's even the tiniest POSSIBILITY that the E/M is even touching the gray area of the surgery, either directly or indirectly, I personally wouldn't bill it unless the documentation is incredibly specific and detailed.